Events and social policy: an exploration of the influence of two homicides on developments in mental illness social policy in England 1985-2000

Background. A number of commentators (Holloway 1996 Muijen 1996a; 1996b) have suggested that two events in the form of homicides carried out by mental health service users came to exert a disproportionate influence on English mental health policy over the period 1985-2000. In particular it has been suggested that the events formed the focus for a ‘moral panic’ caused by ‘irresponsible’ and ‘sensationalist’ reporting in UK newspapers (Neal 1998; Prins and Swan 1998). Aims. In the light of such claims this study critically explores the role played by the deaths of Jonathan Zito and Isabel Schwarz play in establishing violent assaults perpetrated by people experiencing mental illness as a ‘social problem’. It examines whether a shift in the discourse on mental illness took place in UK newspapers and explores how the deaths of Isabel Schwarz were and Jonathan Zito were framed in terms of causal responsibility. Finally it evaluates what influence, if any, the deaths in question had on the social policy agenda. Design. Case study / mixed design integrating quantitative and qualitative methods. Method. Content analysis consisting of a longitudinal analysis of the nature of the representation of mental illness changed over the period in two UK newspaper. Framing a sub-type of discourse analysis examined changes in the discourse of mental illness and the effects of the emergence of the community care tragedy as a ‘new’ narrative. It was also used to examine the potential influence on social policy on mental illness of changes in societal level frames particularly the emergence of the risk society. Results. The content analysis found that mental illness appeared increasingly in the context of a threat to public safety in newspapers over the period but that the overall representation was more balanced. The framing analysis identified and evidenced a competitive process in framing the issue of homicides committed by service users with mental health problems and demonstrated the potential influence of macro level social frames on the policy making proce

From MORAL PANIC to MORAL ACTION: Social Policy and Violence in Human Services

The management of high-risk behaviours from consumers of human services remains a controversial area of practice. Within this broader agenda the use of physical restraint has emerged as a key, if implicit, dilemma for social policy agendas on both sides of the Atlantic. The nature of acceptable methods is the focus of contending perspectives and belief systems. This paper will examine the beliefs and paradigms which sustain the current absence of effective regulation of physical restraint, and suggest that the impact of specific attributional and explanatory paradigms effectively maintains the current social policy vacuum on acceptable approaches and the continuing use of high risk methods. Achieving safer practice in behavioural management requires a paradigm shift which involves the recognition and rejection of the current individualising paradigm in favour of a broader, holistic approach in which the significance of contextual service factors are recognised and addressed and the use of high tariff restraint techniques rigorously monitored and restricted

Violence towards mental health nurses in England and the nature of the policy response: a frame analysis

Nurses working in services for people with mental health problems are twice as likely to be assaulted as nurses working in general hospital settings (Health Care Commission 2007). The emergence of the issue of violence towards nurses as a social problem has however been accompanied by a contest to date unexamined, between conflicting ‘frames’ of the problem, which this paper seeks to make transparent. Two distinct ‘master’ frames are discussed the ‘individualising’ and the ‘co-creationist’. It is concluded that the influence of these frames has influenced the nature of responses to the problem but the recent dominance of the individualising frame is being challenged by the emergence or perhaps re-emergence, of the ideals and values of the therapeutic community

Accounting for Accountability: A Discourse Analysis of Psychiatric Nurses’ Experience of a Patient Suicide

Whilst the experience of a patient suicide is likely to have a significant impact upon the nurses who had been providing care, little work has actually explored this experience in any depth. In this article we explore how two psychiatric nurses construct and orient to accountability when talking of their experiences of a patient suicide. Discourse analysis was used to explore particular phases that the nurses oriented to in their accounts: scene setting; risk assessment; attributing for the suicide. Findings highlight the different, sometimes contradictory, ways the nurses attended to interactional concerns relating to implicit accountability and potential inferences of blame. Analysis of the nurses’ talk can make a valuable contribution to understanding the nature and the impact of ‘accountability’ in a mental health setting and so help nurses and other professionals gain an insight into their practice. The results from this study suggest that as a consequence of internalising fundamentally unrealisable expectations regarding suicide prevention, nurses can hold themselves to blame raising significant concerns around their needs in terms of support, which may not be recognised. This paper also makes a valuable contribution to our methodological understanding and the value of using discourse analysis in this setting

Ambiguity Uncertainty and Risk: Reframing the task of suicide risk assessment and prevention in acute in-patient mental health

The work of the National Confidential Inquiry into Suicide by People with Mental Illness has served to draw attention to the issue of suicide amongst users of mental health services including inpatient and provided the basis for a series of recommendations aimed at improving practice (Appleby et al., 2001, NIMHE 2003). Such recommendations include further training on risk assessment for practitioners. However, representing the problem of suicide as one which can be 'managed' by risk assessment particularly quantitative actuarial approaches implicitly misrepresents the phenomena of suicidality as something which can predicted and therefore managed may be inherently unpredictable at the level of the individual over the short term. We need instead to acknowledge that our work with service users who may be contemplating suicide embraces and acknowledges both uncertainty and ambiguity and seeks to assess risk phenomenologically at the level of the individual such that by understanding their reasons for living and dying we can work in partnership with them to find hope

Restraint in mental health settings: is it time to declare a position?

The emergence of a drive to reduce restrictive interventions has been accompanied particularly in the UK by a debate focussing on restraint positions. Any restraint intervention delivered poorly can potentially lead to serious negative outcomes. More research is required to reliably state the risk attached to a particular position in a particular clinical circumstance.Declaration of interestF.S. is a consultant psychiatrist in Psychiatric Intensive Care at the Maudsley Hospital, London. He is on the Executive Committee of the National Association of Psychiatric Intensive Care and Low Secure Units, and was a member of the National Institute for Health and Care Excellence Guideline Development Group for the Short-Term Management of Aggression and Violence (2015). J.P. is a senior lecturer at the Faculty of Health and Life Sciences, Coventry University. E.B. is a consultant and expert witness in violence reduction and the use of physical interventions, independent expert to the High Secure Hospitals Violence Reduction Manual Steering Group and a member of the College of Policing Guideline Committee Steering Group and Mental Health Restraint Expert Reference Group. B.P. is the clinical director for Crisis and Aggression Limitation and Management (CALM) Training and formerly a senior lecturer for the Faculty of Health, University of Stirling. He is a nurse and psychotherapist and presently chairs the European Network for Training in the Management of Aggression. A.O'B. is a consultant psychiatrist, the Director of Educational Programmes for the National Association of Psychiatric Intensive Care and Low Secure Units, and the Dean for Students at St George's University of London

Exploiting light-based 3D-printing for the fabrication of mechanically enhanced, patient-specific aortic grafts

Despite polyester vascular grafts being routinely used in life-saving aortic aneurysm surgeries, they are less compliant than the healthy, native human aorta. This mismatch in mechanical behaviour has been associated with disruption of haemodynamics contributing to several long-term cardiovascular complications. Moreover, current fabrication approaches mean that opportunities to personalise grafts to the individual anatomical features are limited. Various modifications to graft design have been investigated to overcome such limitations; yet optimal graft functionality remains to be achieved. This study reports on the development and characterisation of an alternative vascular graft material. An alginate:PEGDA (AL:PE) interpenetrating polymer network (IPN) hydrogel has been produced with uniaxial tensile tests revealing similar strength and stiffness (0.39 ±0.05 MPa and 1.61 ±0.19 MPa, respectively) to the human aorta. Moreover, AL:PE tubular conduits of similar geometrical dimensions to segments of the aorta were produced, either via conventional moulding methods or stereolithography (SLA) 3D-printing. While both fabrication methods successfully demonstrated AL:PE hydrogel production, SLA 3D-printing was more easily adaptable to the fabrication of complex structures without the need of specific moulds or further post-processing. Additionally, most 3D-printed AL:PE hydrogel tubular conduits sustained, without failure, compression up to 50% their outer diameter and returned to their original shape upon load removal, thereby exhibiting promising behaviour that could withstand pulsatile pressure in vivo. Overall, these results suggest that this AL:PE IPN hydrogel formulation in combination with 3D-printing, has great potential for accelerating progress towards personalised and mechanically-matched aortic grafts